Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2012 Oct;19(10):3177-84. doi: 10.1245/s10434-012-2484-2. Epub 2012 Jul 7.
Sentinel lymph node (SLN) dissection has been investigated after neoadjuvant chemotherapy and has shown mixed results. Our objective was to evaluate SLN dissection in node-positive patients and to determine whether postchemotherapy ultrasound could select patients for this technique.
Between 1994 and 2010, 150 patients with biopsy proven axillary metastasis underwent SLN dissection after chemotherapy and 121 underwent axillary lymph node dissection (ALND). Clinicopathologic characteristics were analyzed before and after chemotherapy. Statistical analyses included Fisher's exact test for nodal response and multivariate logistic regression for factors associated with false-negative events.
Median age was 52 years. Median tumor size at presentation was 2 cm. The SLN was identified in 93 % (139/150). In 111 patients in whom a SLN was identified and ALND performed, 15 patients had a false-negative SLN (20.8 %). In the 52 patients with normalized nodes on ultrasound, the false-negative rate decreased to 16.1 %. Multivariate analysis revealed smaller initial tumor size and fewer SLNs removed (<2) were associated with a false-negative SLN. There were 63 (42 %) patients with a pathologic complete response (pCR) in the nodes. Of those with normalized nodes on ultrasound, 38 (51 %) of 75 had a pCR. Only 25 (33 %) of 75 with persistent suspicious/malignant-appearing nodes had a pCR (p = 0.047).
Approximately 42 % of patients have a pCR in the nodes after chemotherapy. Normalized morphology on ultrasound correlates with a higher pCR rate. SLN dissection in these patients is associated with a false-negative rate of 20.8 %. Removing fewer than two SLNs is associated with a higher false-negative rate.
新辅助化疗后已经研究了前哨淋巴结 (SLN) 切除术，结果喜忧参半。我们的目的是评估 SLN 切除术在阳性淋巴结患者中的作用，并确定化疗后超声是否可以选择适合该技术的患者。
1994 年至 2010 年间，150 例经活检证实腋窝转移的患者在化疗后接受 SLN 切除术，121 例接受腋窝淋巴结清扫术 (ALND)。分析化疗前后的临床病理特征。统计分析包括淋巴结反应的 Fisher 确切检验和与假阴性事件相关的多变量逻辑回归。
中位年龄为 52 岁。初诊时肿瘤大小中位数为 2cm。93%（139/150）的患者识别出 SLN。在 111 例识别出 SLN 并进行 ALND 的患者中，15 例 SLN 假阴性（20.8%）。在 52 例超声检查淋巴结正常的患者中，假阴性率降至 16.1%。多变量分析显示，初始肿瘤较小和切除的 SLN 较少（<2）与 SLN 假阴性相关。淋巴结有病理完全缓解（pCR）的患者有 63 例（42%）。在超声检查淋巴结正常的患者中，有 38 例（51%）有 pCR。仅有 25 例（33%）持续存在可疑/恶性表现的淋巴结患者有 pCR（p=0.047）。
大约 42%的患者在化疗后淋巴结有 pCR。超声检查形态正常与更高的 pCR 率相关。在这些患者中进行 SLN 切除术，假阴性率为 20.8%。切除的 SLN 少于 2 个与更高的假阴性率相关。
